Introduction Inflammatory myofibroblastic tumor (IMT), also known as plasma granuloma, is a very rare tumor with varying biological behavior, from completely benign to malignant. IMT can occur in virtually every organ, but cardiac origin is extremely rare. IMT occurs mainly in children and young people. The mainstay of treatment is complete surgical resection of the tumor. We present a case of 28 year old white woman with no contributory medical and family history, who was admitted to hospital because of dyspnea and cough. The transthoracic echocardiography (TTE) showed elevated pulmonary artery systolic pressure up to 61 mm Hg and mild dilation of right chambers. Further assessment by computed tomography showed thrombosis of the main pulmonary artery (PA), narrowing its lumen by 90%, with spread to the lobar and segmental arteries of the left lung - signs of massive pulmonary embolism. During thromboendarterectomy revealed a mass, about 4,1 x 3,1 x 1,8 cm in size, with thrombotic overlays, locating at the right ventricular outflow tract (RVOT) and the pulmonary trunk. Histological examination and Immunohistochemistry studies was consistent with IMT with an intermediate potential of malignancy. A year after the operation, the patient became pregnant. Routine TTE showed low density mobile mass narrowing the pulmonary trunk. The transvalvular blood flow velocity was 2.4 m/s. Cardiac magnetic resonance (CMR) was consistent with echo findings. The pregnancy has been preserved, and after 36 weeks it was decided to perform the birth of a girl by means of a Cesarian section. After 2 months, due to an increase in the size of the tumor and the dyspnea, a reoperation was performed to remove the tumor lining the RVOT and intimately connected with the PA valve, excision of the PA valve. A bioprosthesis was installed. The tumor had an identical morphological picture. Conclusion This case report describes a rare recurrent cardiac inflammatory myofibroblastic tumor involving RVOT and PA. The prognosis after surgical treatment of IMT is usually favorable, but it is known that some tumors recur, and rarely they can even metastasize. The long-term outcome is not well established due to the rarity of these tumors. Abstract P1700 Figure.
АскАр климентьевич ГАдеев, врач сердечно-сосудистый хирург отделения сосудистой хирургии ГАУЗ ГКБ № 7 г. Казани, соискатель кафедры лучевой диагностики ГБОУ ДПО «Казанская государственная медицинская академия» Минздрава России, тел. 8-917-248-11-21, е-mail: snowrider607@ramblerРеферат. Проведен анализ работы двух отделений, оказывающих неотложную помощь больным с ургентной сосудистой патологией в г.Казани.Рутинными методами диагностики заболеваний магистральных и перифери-ческих сосудов являются ультразвуковое исследование (УЗИ) и реже ангиография. Недостатки этих методик диктуют необходимость внедрения методов магнитно-резонансной томографии (МРТ) и компьютерной томо-графии (КТ) в ангиорежимах, как наиболее чувствительных, безопасных методов, с минимальным процентом ложноотрицательных результатов в работу отделений сосудистой хирургии. Основное место по количеству экстренной госпитализации занимают острые тромбозы глубоких вен нижних конечностей. Данная категория больных нуждается в длительном лечении и инструментальном наблюдении, что ведет к большим матери-альным и моральным затратам. Решением данной проблемы может явиться наличие дневного стационара. Второе место занимают тромбозы периферических артерий. Наличие у этих больных тяжелой сопутствующей патологии требует применения сочетанных «открытых» и рентгенэндоваскулярных вмешательств в условиях гибридной операционной. Современное состояние сосудистой хирургии диктует необходимость в профессио-нальной переподготовке ангиохирургов по специальности «рентгенэндоваскулярная диагностика и лечение». Назрела необходимость разработки скрининг-программ по раннему выявлению наиболее распространенных заболеваний сосудов, технической оснащенности современным оборудованием отделений сосудистой хирур-гии, функционирования консультативных кабинетов и дневных стационаров, организации помощи больным, нуждающихся в формировании постоянного сосудистого доступа, а также больным с критической хронической ишемией нижних конечностей. Ключевые слова: неотложная помощь, сосудистая хирургия, острая сосудистая патология. Unsolved problems of emergency vascUlar sUrgery dAmotsev, Head of the department of nephrology and hemodialysis UAIPH «City emergency hospital number 2», KazanAbstract. The work of two departments that provide emergency care to patients with urgent vascular pathology in Kazanwas analyzed.Routine methods of diagnosis of diseases main and peripheral vessels are ultrasound examinationand less angiography.The disadvantages of these methods necessitate the introduction of methods of magnetic resonance imaging and computed tomography in vascular regime as the most sensitive, safe methods, with a minimum percentage of false negative results in the work of the department of vascular surgery. The acute deep vein thrombosis of the lower limbs take the main place of the number of emergency hospitalization.This category of patients needs in long-term treatment and instrumental monitoring that leads to great material and moral costs.Solution of this problem may be the availabili...
Acute aortic dissection is a highly disabling disease, due to severe neurological deficits caused by damage to the brachiocephalous arteries. The study enrolled 92 patients, 74% of them were men and 26% women. Everybody underwent extracranial duplex scanning and/or multispiral computer tomography of neck vessels. The narrowing of the true lumen by 60% and either the occurrence of a stroke or a transient ischemic attack against the background of the involvement of brachiocephalous arteries in the process of delamination was considered to be a significant defeat. Brachiocephalic stem was the most frequently involved (52.1%). Significant lesions were more often identified in the right common carotid artery (10.8%). Higher lethality (33%) was found in the group where brachiocephalous arteries were intervened than in the group of non-operated arteries (24%) (p = 0.048). In the first group ischemic events were revealed only before and during the surgical intervention, in the second group - only in the postoperative period. Interventions on brachiocephalic arteries in acute aortic dissection are associated with higher lethality and occurrence of ischemic events. A classification taking into account pathogenetic mechanisms of acute cerebral ischemia in case of brachiocephalous artery damage has been proposed.
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